After decades of research describing the poor sleep quality of critically ill patients, clinical investigations are beginning to focus on the effects of intensive care unit (ICU)-associated sleep disturbances on patient outcomes. This interest has arisen from emerging data suggesting that ICU-related sleep deprivation and disruption contributes to cardiovascular and immune dysfunction, metabolic derangements, delirium, other neuropsychological disturbances, and prolonged recovery. However, few sleep-related interventions have been evaluated to improve ICU patients'outcomes. The purpose of this project is to evaluate the effect of sleep improvement interventions on patient outcomes in a single medical ICU. The proposed study is a MICU- wide, multi-stage sleep improvement project involving multi-faceted sleep promoting interventions and minimization of sleep disturbances. Promotion of sleep in the ICU will occur in three incremental stages over a 6-month period: Stage 1) environmental interventions (minimization of overhead pages/alarms, dimming of lights, closing patients'doors);Stage 2) non-pharmacologic individualized interventions (earplugs, eye masks, soothing music), and Stage 3) establishing a guideline regarding use of appropriate sleep promoting medications. Effectiveness of these staged sleep improvement interventions will be evaluated by daily collection of the Richards-Campbell Sleep Questionnaire of perceived sleep quality for every MICU patient during their ICU stay, and eligible ICU survivors will complete a validated "Sleep in the ICU" questionnaire and a short battery of neurocognitive tests after ICU discharge. The ultimate goal of this project is to evaluate simple and feasible interventions that can be widely used in the ICU setting to improve sleep and patient outcomes. PUBLIC HEALTH RELEVANCE: We are trying to help patients in the Intensive Care Unit sleep better. In our research study, we will get rid of loud noises and bright lights in the Intensive Care Unit, and give medicine to help patients sleep. We will ask patients about their sleep and see if better sleep helps with thinking or healing.